Healthcare Provider Details

I. General information

NPI: 1134382369
Provider Name (Legal Business Name): ELAINE REEVES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

104 UNION AVE SUITE 804
SYRACUSE NY
13203-1843
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5111
  • Fax: 315-703-5049
Mailing address:
  • Phone: 315-703-5049
  • Fax: 315-703-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332016
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number332016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: